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Accepted for/Published in: Journal of Medical Internet Research

Date Submitted: Oct 2, 2025
Date Accepted: Mar 30, 2026

The final, peer-reviewed published version of this preprint can be found here:

Uptake of Clinical Decision Support Systems Among Health Care Professionals in Six European Countries and the United States: Cross-Sectional Survey Within the I-CARE4OLD Project

Exmann CJ, Hiltunen AM, Haavisto I, Salminen A, Messo M, Nuutinen M, Hoogendoorn M, Boorsma W, Howard EP, Pešić V, Alon M, Mammarella F, Liperoti R, Švihnosová O, Fialová D, Drapała N, Szczerbińska K, Declercq A, van Hout HP, De Almeida Mello J

Uptake of Clinical Decision Support Systems Among Health Care Professionals in Six European Countries and the United States: Cross-Sectional Survey Within the I-CARE4OLD Project

J Med Internet Res 2026;28:e85071

DOI: 10.2196/85071

PMID: 42274158

Uptake of clinical decision support systems among healthcare professionals in six European countries and the USA: A cross-sectional survey within the I-CARE4OLD project

  • Collin J.C. Exmann; 
  • Anna-Maria Hiltunen; 
  • Ira Haavisto; 
  • Anna Salminen; 
  • Maikki Messo; 
  • Mikko Nuutinen; 
  • Mark Hoogendoorn; 
  • Wiebe Boorsma; 
  • Elizabeth P Howard; 
  • Vanja Pešić; 
  • Mor Alon; 
  • Federica Mammarella; 
  • Rosa Liperoti; 
  • Olena Švihnosová; 
  • Daniela Fialová; 
  • Natalia Drapała; 
  • Katarzyna Szczerbińska; 
  • Anja Declercq; 
  • Hein P.J. van Hout; 
  • Johanna De Almeida Mello

ABSTRACT

Background:

The use of clinical decision-support systems (CDSS), such as clinical decision rules, algorithms, or machine learning (ML) based applications has gained attention in recent years. However, their adoption and effectiveness may vary across different healthcare systems and settings.

Objective:

This study aims to describe and compare the current use of various decision-support and prediction tools in long-term care for older people across health professionals from 6 European countries and the USA.

Methods:

This study analysed the survey of a CDSS pilot study in a purposive sample of health professionals working with older adults with complex chronic conditions from six European countries and the USA. The survey included participants’ general background information, their current usage of decision support tools, and attitudes on the potential benefits of CDSS.

Results:

A total of 151 professionals participated in the pilot study. Most participants were physicians (56.3%) or nurses (37.7%). Our results show significant variation in the adoption and use of decision-support tools across samples from the seven countries. Most currently used CDSS were for diagnostic purposes or concerned guideline implementation, not aimed at prognostic information. In contrast, prognostic tools were most frequently mentioned by respondents as being valuable improvements to clinical practice.

Conclusions:

While some country samples reported well-integrated digital health infrastructures and higher CDSS adoption rates, others still face challenges in implementing these. However, we found multiple examples of emerging tools. Our findings highlight the need for improvement of current CDSS and development and implementation of particularly predictive CDSS. Clinical Trial: Not applicable -> see protocol registration


 Citation

Please cite as:

Exmann CJ, Hiltunen AM, Haavisto I, Salminen A, Messo M, Nuutinen M, Hoogendoorn M, Boorsma W, Howard EP, Pešić V, Alon M, Mammarella F, Liperoti R, Švihnosová O, Fialová D, Drapała N, Szczerbińska K, Declercq A, van Hout HP, De Almeida Mello J

Uptake of Clinical Decision Support Systems Among Health Care Professionals in Six European Countries and the United States: Cross-Sectional Survey Within the I-CARE4OLD Project

J Med Internet Res 2026;28:e85071

DOI: 10.2196/85071

PMID: 42274158

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